Advocate for the inclusion of Traditional Chinese Medicine in the National Health Literacy Strategy 2025–2035

The Slovenian Association of Chinese Medicine and Acupuncture (SZKMA) supports the objectives of Slovenia's Proposal for a National Health Literacy Strategy 2025–2035 (NHLS). Health literacy is a key factor for empowering individuals, reducing health inequalities, and ensuring a more effective healthcare system. SZKMA shares common goals with the Slovenian Ministry of Health of empowering citizens, promoting holistic well-being, fostering intersectoral collaboration, and strengthening the evidence base and regulatory frameworks for health practices.

We are writing to suggest one addition to the proposal:

Under Strategic Sub-goal 1: Empowering residents with clear, understandable, reliable, and culturally appropriate health information

• Amendment to: Stran 42, podcilj 3.1, odstavek 3, točka 'Kulturna ustreznost'.

  • Proposed Text: "Kulturno ustrezne informacije upoštevajo raznolikost v prepričanjih, običajih in vrednotah različnih skupin prebivalstva, kar omogoča boljše razumevanje, sprejemljivost in upoštevanje zdravstvenih priporočil." (Culturally appropriate information takes into account the diversity of beliefs, customs, medicine systems and healing methods, and values of different population groups, enabling better understanding, choices and decision making, acceptance, and adherence to health recommendations.

• Justification: Zakon o zdravilstvu (ZZdrav) explicitly lists various kinds of medicine systems and healing methods accepted in Slovenia. In particular, Traditional Chinese Medicine (TCM) is a form of medicine that emphasizes “health cultivation” and “preventive medicine”. According to the WHO, “traditional, complementary and herbal medicines can offer several benefits when used in conjunction with conventional medical treatments for many health conditions, such as access to a wider range of treatments, palliative care in managing the side effects of conventional treatments, improved mental and emotional well-being, and increased patient satisfaction.”

Just like the importance of health literacy, although TCM and other Traditional, complementary and integrative medicine (TCI) is gaining awareness in many European countries, including Slovenia, efforts are often not coordinated in a national or regional policy, strategy, or action plan. For example, in 2024, SZKMA collaborated with the University of Novo mesto, Faculty of Health Sciences to initiate a “Integrativna podpora skupnosti za duševno zdravje- Pro bono klinika z akuterapijo in zdravstveno pismenostjo Yang Sheng” project in the municipality of Novo mesto. However, our proposal was not accepted, instead, only infrastructure building projects were chosen by the municipality, clearly indicating an imbalance in their development preference. 

SZKMA is the first and only professional TCM association that fulfills the European Traditional Chinese Medicine Association (ETCMA)’s minimal education criteria. We are also an important contributor of the latest 2023 ETCMA’s Core Competencies 

for Chinese medicine Practitioners document and the establishing accreditation board for TCM schools across Europe. We believe TCM can contribute to the National Health Literacy Strategy. We will further facilitate Measure 3.1: Inclusion of the concept of health literacy in formal educational programs for future healthcare professionals, Measure 3.2: Development of competences of healthcare professionals in the field of health literacy, and Strategic Sub-goal 9 International Cooperation, because TCM is a well-developed, well-studied and regulated profession in various countries. There is ample research evidence on the safety of TCM treatment, cost effectiveness and positive effects on various health conditions, including many chronic diseases. The TCM practitioner training is also well defined under the WHO benchmark, many European professional associations’ guidelines, including a complete law on TCM and other non-conventional therapies in Portugal, an EU country. 

TCM can also support Measure 4.2: Development and implementation of integrated pathways for people with chronic diseases in the health system and the broader context of care and 3.4 sub goal 4: Effective management of chronic diseases requires a holistic approach that includes both medical treatment at all levels of healthcare and the active role of patients in taking care of their own health. Here are several strong pieces of evidence supporting Traditional Chinese Medicine (TCM) for health promotion, cost-effectiveness, and chronic disease management: 

1. Cost-Effectiveness of TCM in Chronic Obstructive Pulmonary Disease (COPD)

A study analyzing the TCM formula Yupingfeng granules combined with conventional treatment for COPD patients in China showed significant cost-effectiveness. Using a Markov model over 10 years, the incremental cost-effectiveness ratio (ICER) was ¥2,123.04 per quality-adjusted life year (QALY), well below the threshold of one-time per capita GDP, indicating that adding Yupingfeng granules reduces acute exacerbations and follow-up treatment costs, making it a cost-effective therapeutic strategy for COPD management.

2. Adjunctive Chinese Medicine Therapy for Non-Small Cell Lung Cancer (NSCLC)

A nationwide cohort study in Taiwan involving over 43,000 NSCLC patients found that adjunctive Chinese medicine therapy significantly reduced mortality risk when administered for 181–365 days. The cost-effectiveness analysis showed an ICER of 880,908 NT$/year, which is below the WHO-recommended threshold of three times the GDP, demonstrating economic benefit alongside improved survival outcomes. This supports the role of TCM in chronic disease management and cost-effective health promotion.

3. Acupuncture as a Cost-Effective Treatment for Chronic Conditions

Acupuncture, a key modality within TCM, is increasingly recognized globally as a cost-effective treatment, especially for chronic conditions such as pain and stress. Its integration into healthcare systems offers a non-pharmacological option that can reduce healthcare costs and improve quality of life.

4. Health-Related Quality of Life and Cost-Effectiveness of TCM Therapies

A literature review analyzing various TCM therapies (including acupuncture and Tai Chi) found that while evidence is still limited, available studies suggest TCM can improve health-related quality of life (HRQOL) and be cost-effective. Most cost-effectiveness evaluations reported better outcomes at acceptable incremental costs, supporting TCM’s potential in health promotion and chronic disease care.

This addition to the document ensures that health information is comprehensive and addresses diverse health approaches that individuals may seek, aligning with SZKMA's goal to promote access to reliable, evidence-based information about TCM for healthcare. It also signifies the proposal’s openness to diverse, evidence-based integrative health approaches. It resonates with the NHLS objective on integrirane poti oskrbe (integrated care pathways) for chronic diseases to provide comprehensive care.